Individual
ABIGAIL HAGAN SOUTHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
312 W HIGH ST, LEBANON, KY 40033-1428
(270) 692-9559
(270) 692-9236
Mailing address
312 W HIGH ST, LEBANON, KY 40033-1428
(270) 692-9559
(270) 692-9236
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3015055
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3015055
NURSE PRACTITIONER LICENSE
KY
Enumeration date
09/04/2020
Last updated
09/04/2020
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